ATT-24 Affidavit (Rev. 7/11)
State of Georgia
Douglas J. MacGinnitie
Commissioner Department of Revenue Howard A. Tyler
Director
Alcohol & Tobacco Division
Suite Number 4235
1800 Century Blvd., N.E.
Atlanta, Georgia 30345
(404) 417-4900
INSTRUCTIONS FOR APPLYING FOR TOBACCO EXCISE TAX REFUND
Georgia Code Section 48-11-15 provides that the Commissioner may, in certain
instances, issue refunds for excise taxes paid on tobacco by a distributor, dealer or
taxpayer when it can be shown to the Commissioner’s satisfaction that the tobacco is
unfit for human consumption or sale, and has been destroyed or shipped out of the state.
Procedures for Obtaining a Tobacco Tax Refund
1. The Manufacturer must complete the most recent revision of Form ATT-24-Affidavit. Applications
filed on forms other than the most recent revision of Form ATT-24-Affidavit cannot be approved.
The form must be completely filled out prior to submission. A copy of the first page must be left
with the retailer from whom the tobacco was picked up.
2. The fully completed application form must be filed, by the taxpayer, with the Alcohol and Tobacco
Division (“ATD”) with ATT-24 Schedule C. In order to be timely filed, the application must be
received by the Alcohol and Tobacco Division, P. O. Box 49728, Atlanta, GA 30359 within 90
days from the date payment of taxes was received by the Revenue Department.
3. The ATD office will investigate the claim for tax credit and upon the completion of this
investigation, will advise taxpayer of approval or disapproval of claim. Grounds for denying
claim include, but are not limited to, a false statement on the application, untimely filing of
an application, indebtedness by claimant to the State of Georgia, present violation by
claimant of any tobacco law, or failure to meet any statutory requirement for a refund.
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ATT-24 Affidavit (Rev. 7/11)
Department of Revenue FOR DEPARTMENT USE ONLY
ALCOHOL & TOBACCO DIVISION
SUITE NUMBER 4235
1800 CENTURY BLVD., N.E.
ATLANTA, GEORGIA 30345
APPLICATION FOR EXCISE TAX REFUND FOR TOBACCO UNFIT FOR HUMAN CONSUMPTION
DATE: _____________________ MANUFACTURER LICENSE NUMBER: __________________________________
MANUFACTURER: _________________________ REPRESENTATIVE: ____________________________________
LOCATION TOBACCO PICKED UP: ___________________________________________________________________
RETAILER NAME: _______________________________ RETAIL LICENSE NUMBER: ________________________
ITEM PICKED UP REASON UNFIT AMOUNT OF TAX PAID
I CERTIFY THE ITEMS LISTED ABOVE HAD GEORGIA EXCISE TAX PAID ON THEM AND THEY ARE UNFIT FOR
HUMAN CONSUMPTION. I FURTHER CERTIFY THESE ITEMS WERE PICKED UP TO BE TRANSPORTED TO THE
MANUFACTURER’S PREMISE TO BE DESTROYED OR SHIPPED OUT OF STATE.
PRINT MANUFACTURER’S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________
MANUFACTURER’S REPRESENTATIVE SIGNATURE: ___________________________________________________
I CERTIFY THAT THE MANUFACTURER’S REPRESENTATIVE REMOVED THE ABOVE ITEMS FROM MY LICENSED
PREMISE AND LEFT A COPY OF THIS RECIEPT WITH ME. I FURTHER CERTIFY THAT THE MANUFACTURER’S
REPRESENTATIVE DID NOT COMPENSATE ME IN ANY WAY FOR THE EXCISE TAX PAID ON THESE ITEMS.
PRINT RETAIL REPRESENTATIVE’S NAME AND PHONE NUMBER: ________________________________________
RETAIL REPRESENTATIVE SIGNATURE: ______________________________________________________________
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ATT-24 Affidavit (Rev. 7/11)
Department of Revenue FOR DEPARTMENT USE ONLY
ALCOHOL & TOBACCO DIVISION
SUITE NUMBER 4235
1800 CENTURY BLVD., N.E.
ATLANTA, GEORGIA 30345
CERTIFICATION OF DESTRUCTION
I CERTIFY THAT THE ABOVE LISTED ITEMS WERE DESTROYED ON (DATE/TIME) ________________________
AT (LOCATION) ____________________________________ BY THE FOLLOWING METHOD: __________________
________________________________________________________________________________________________
PRINT MANUFACTURER’S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________
MANUFACTURER’S REPRESENTATIVE SIGNATURE: ___________________________________________________
PRINT WITNESS NAME AND PHONE NUMBER: ________________________________________________________
WITNESS SIGNATURE: ____________________________________________________________________________
OR
CERTIFICATION OF SHIPMENT OUT OF STATE
IF THE ITEMS WERE NOT DESTROYED I CERTIFIED THEY WERE SHIPPED OUT OF THE STATE OF GEORGIA ON
(DATE/TIME) _________________________ TO (LOCATION) ____________________________________________.
PRINT MANUFACTURER’S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________
MANUFACTURER’S REPRESENTATIVE SIGNATURE: ___________________________________________________
PRINT WITNESS NAME AND PHONE NUMBER: ________________________________________________________
WITNESS SIGNATURE: ____________________________________________________________________________
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